Provider Demographics
NPI:1790966257
Name:BRANTLEY, RICHARD T SR (RPT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:T
Last Name:BRANTLEY
Suffix:SR
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1 CHOCTAW WAY
Mailing Address - Street 2:ATTN: PHYSICAL THERAPY
Mailing Address - City:TALIHINA
Mailing Address - State:OK
Mailing Address - Zip Code:74571-2022
Mailing Address - Country:US
Mailing Address - Phone:918-567-7000
Mailing Address - Fax:918-567-7119
Practice Address - Street 1:1 CHOCTAW WAY
Practice Address - Street 2:ATTN: PHYSICAL THERAPY
Practice Address - City:TALIHINA
Practice Address - State:OK
Practice Address - Zip Code:74571-2022
Practice Address - Country:US
Practice Address - Phone:918-567-7000
Practice Address - Fax:918-567-7119
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist